Hyperferritinemia and markers of inflammation and oxidative stress in the cord blood of HIV-exposed, uninfected (HEU) infants

Abstract

OBJECTIVES : The purpose of this study was to evaluate markers of iron status and inflammation/oxidative stress in maternal and cord blood (CB) of HIV-infected and HIVuninfected women as potential mechanisms for poor outcomes among HIV-exposed, uninfected (HEU) infants. METHODS : Maternal venous and cord blood (CB) specimens were obtained from eighty-seven pregnant women (45 HIV-infected and 42 HIV-uninfected) enrolled at Kalafong Hospital, Pretoria, South Africa. Iron status (serum iron, ferritin, transferrin, transferrin saturation, soluble transferrin receptor [sTfR], sTfR/log ferritin [sTfR/F index], antenatal exposure to inflammation (CB C-reactive protein, interleukin-6, haptoglobin switch-on status) and oxidative stress (total radical trapping ability of CB plasma [TRAP], and chronic oxidative stress (soluble receptor of advanced glycation end-products [sRAGE]) were assessed by laboratory studies. RESULTS : There were no differences in maternal hematological and iron indices except that HIVinfected mothers had decreased WBC counts (P=0.048) and increased serum ferritin (P=0.032). Ferritin levels were significantly higher in CB than in maternal blood (P<0.001) in both groups and further elevated in the CB of HEU infants (P=0.044). There was also an inverse relationship between CB sTfR/F index and sRAGE (r=-0.43, P=0.003) in the HIV-infected but not HIVuninfected group. CONCLUSIONS : Our study shows for the first time that ferritin is significantly elevated in CB of HEU infants. The inverse relationship between sTfR/F index and sRAGE in CB suggests that chronic oxidative stress or RAGE axis activation in HIV-infected mothers may play a role in modulating ferritin levels.